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Mental Health IOP

Valerie1 1 year ago in User Group Help updated by TVano 1 year ago 5

Hi, I am new to contracting and my supervisor wants me to get us set up for IOP for mental health.  I see some insurers require us to be contracted as a facility but others, it does not look that way.  Do you know, do we need to be contracted as a facility and bill on a UB04 or as a clinic and bill on the HCFA with the H2019 codes?  any help is very much appreciated as I am quite confused.

Valerie,

To bill on a UB04 you have to be contracted as a Facility.  We are contracted as a Facility to provide IOP services for both Mental Health and Substance Abuse.  Most all insurances wanted us to bill on a UB04, but you will need to check with each insurance as there were a few that wanted us to bill on the HCFA.  Being contracted as a facility also helps if you ever have multiple providers providing the IOP services or if they are a non-credentialed provider such as a clinician who has an in-training licensure who is working on obtaining their hours for permanent licensure.  Hope this helps.

thank you, that was what I thought but my boss swears we don't need to be a facility.

Typically you need to submit a proposal to each insurance company for IOP level of care and they will decide if your program meets criteria.  Each insurance company determines which code you get to bill.  H2019 is for DBT.

Hi, we are getting started on opening up a MH IOP clinic and I need some help with coding.  I used to bill for SA so I know the concept and process but not the specific codes for IOP.  Is there anyone willing to help coach me on this?

tvanovermeiren@northwoodchildren.org